Psychotherapy Termination Summary Form
Use this form to summarize and document the conclusion of psychotherapy treatment sessions.
Client First Name
*
Client Last Name
*
Date of Termination
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Therapist Name
*
Presenting Issues at Intake
Summary of Treatment Progress
Interventions Used
Reason for Termination
Please Select
Treatment goals achieved
Client discontinued
Referral to another provider
Other
Recommendations for Future Care
Additional Comments
Submit Summary
Should be Empty: